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Mental Preparation for Surgery

Posted Nov 21 2008 4:27pm
I'm in the operating room right now, between cases. Having been on vacation, it's been about three weeks since I've performed surgery. The most common procedure I perform is cataract surgery, and I have four scheduled today -- two down, two to go.

Even though I've done cataract surgery like a gazillion times, and it's pretty much an automatic thing for me, I still sat for a few moments last night and just went through the procedure in my head. Incision with the 15 degree blade, intracameral lidocaine, Viscoat, incision with the 2.75 mm keratome, capsulorhexis, hydrodissection, rotation of the nucleus, insertion of the chopper and phaco tip, chop, spin, aspirate, chop, spin aspirate, chops, spin, aspirate, chop, spin aspirate, switch to I/A, aspirate cortex, insert intraocular lens into cartridge, fill chamber with Viscoat, insert intraocular lens, aspirate Viscoat, check the incision.

I find this mental preparation, especially after an absence, to be very useful. There are studies that show your brain doesn't know the difference between mental visualization and the actual act, so visualization can serve as a means of giving you "experience" and getting you back into practice.

One of the things that still surprises me during surgery is how much of an artistic act it has become for me. Sure, it's a linear sequence of steps, requiring the left brain to be on top of things, but once that is mastered, and the left brain is doing its thing in the background, I seem to switch over to right brain mode. Time sort of stands still. I can't talk during surgery because it requires my right brain to turn off. Some surgeons like music during surgery. I need the operating room silent. It's one of the most enjoyable things I do.
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